New insight into the iliofemoral ligament based on the anatomical study of the hip joint capsule
New insight into the iliofemoral ligament based on the anatomical study of the hip joint capsule
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DOI：
10.1111/joa.13140
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发表时间：
2019-12-22
影响因子：
2.4
通讯作者：
Akita, Keiichi
中科院分区：
文献类型：
--
作者：
Tsutsumi, Masahiro;Nimura, Akimoto;Akita, Keiichi
髂股韧带形成于髋关节囊的前上部，对髋关节的稳定性起着重要作用。尽管臀小肌和髂腰肌的肌腱和深层腱膜部分连接到关节囊的同一区域，但关节囊与肌腱和深层腱膜之间连接的精确位置仍不清楚。肌腱和腱膜与关节囊连接的位置可以阐明髂股韧带是否可以被视为动态稳定器。本研究调查了关节囊前上部区域与臀小肌和髂腰肌的肌腱和深层腱膜之间的关系。对 9 具尸体（5 名男性；4 名女性；平均死亡年龄 76.7 岁）的 14 个髋关节进行了分析。对十个髋关节进行宏观分析，对四个髋关节进行组织学分析。在宏观分析过程中，将关节囊与髋臼边缘和股骨分离，并使用显微计算机断层扫描（micro-CT）测量其局部厚度。臀小肌腱与关节囊相连，该连接的外侧端在股骨粗隆间线的上外侧端与股骨结节相连。髂腰肌深部腱膜也与关节囊相连，其前缘的下内侧端与转子间线的下内侧端相对应。在显微CT分析中，在与臀小肌腱连接的基部和髂腰肌深层腱膜的前缘处观察到包膜增厚。组织学研究表明，臀小肌腱和髂腰肌深层腱膜与髋关节囊相连。根据肌腱和腱膜连接的形态、局部囊膜增厚和组织学连续性，认为髂股韧带的横行部分和降部为关节囊，其纤维分别按照与臀小肌腱的连接和髂腰肌深层腱膜的连接排列。因此，所谓的髂股韧带可以被视为动态稳定器，具有通过囊复合体将肌肉力量传递到关节的能力。这种解剖学知识可以更好地理解髋关节稳定机制。
The iliofemoral ligament, which plays an important role in hip joint stability, is formed on the anterosuperior region of the hip joint capsule. Although the tendon and deep aponeurosis of the gluteus minimus and iliopsoas are partly connected to the same region of the capsule, the precise location of the connections between the joint capsule and the tendons and deep aponeuroses remains unclear. The locations of the tendinous and aponeurotic connections with the joint capsule may clarify whether the iliofemoral ligament can be regarded as the dynamic stabilizer. This study investigated the relationships between the anterosuperior region of the joint capsule and the tendon and deep aponeurosis of the gluteus minimus and iliopsoas. Fourteen hips from nine cadavers (five males; four females; mean age at death 76.7 years) were analyzed. Ten hips were macroscopically analyzed, and four were histologically analyzed. During macroscopic analysis, the joint capsule was detached from the acetabular margin and the femur, and its local thickness was measured using microcomputed tomography (micro-CT). The gluteus minimus tendon was connected to the joint capsule, and the lateral end of this connection was adjoined with the tubercle of the femur at the superolateral end of the intertrochanteric line. The deep aponeurosis of the iliopsoas was also connected to the joint capsule, and the inferomedial end of its anterior border corresponded with the inferomedial end of the intertrochanteric line. In the micro-CT analysis, capsular thickening was observed at the base of the connection to the gluteus minimus tendon and at the anterior border of the deep aponeurosis of the iliopsoas. A histological study showed that the gluteus minimus tendon and the deep aponeurosis of the iliopsoas were continuous with the hip joint capsule. Based on the morphology of the tendinous and aponeurotic connections, local capsular thickening and histological continuity, the transverse and descending parts of the iliofemoral ligament were the joint capsules, with fibers arranged according to the connection with the gluteus minimus tendon and the deep aponeurosis of the iliopsoas, respectively. Therefore, the so-called iliofemoral ligament could be regarded as the dynamic stabilizer, with the ability to transmit the muscular power to the joint via the capsular complex. This anatomical knowledge provides a better understanding of the hip stabilization mechanism.